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1 For office use only Applicant Number: OUTWOOD GRANGE ACADEMIES TRUST APPLICATION FORM Please note this post involves working with children or vulnerable adults so appointment will be subject to Disclosure and Barring Service clearance. See supporting information for further details of the Trust s Child Safeguarding Policy. JOB DETAILS Job title Please complete in BLACK ink or TYPE. Please complete every section. YOU CAN ALSO APPLY ONLINE AT Vacancy number Closing date PERSONAL DETAILS Title Surname First Names Previous names (if any) Preferred first name Date of birth National Ins No Address Postcode Daytime telephone Mobile telephone address

2 FOR TEACHING VACANCIES ONLY Teacher reference number & Date qualified as a teacher Type of teacher training undertaken and phase e.g. GTP/Secondary Subjects qualified to teach Do you have Qualified Teacher Status? Yes/No Have you successfully completed: Your probationary/induction year? Yes/No POST-18 EDUCATION AND TRAINING Please give details about all the education and qualifications you have including degrees with class and division and teaching certificates (if relevant). If you are shortlisted, evidence of all qualifications should be brought to interview. Please continue on a separate sheet if necessary. Establishment Full time or part time Qualifications (indicate class and division) Dates attended From To Date of final exam Other courses and INSET in which you have been involved during the past three years and which you consider relevant to this post, please indicate who provided it and start/finish dates.

3 PRE-18 EDUCATION AND TRAINING Please include all education and training up to the age of 18, including all qualifications obtained with the grade achieved and the title of the award. Please continue on a separate sheet if necessary. Establishment Full time or part time Qualifications (indicate grade and qualification name) Dates attended From To Date of final exam EMPLOYMENT RECORD Please give details of all previous jobs including temporary or voluntary work in chronological order ending with your present post. Please include periods when you were not working as all time must be accounted for and may be checked. Continue on separate sheet if necessary. CURRENT POST Name and address of Employer: Job title: Date started: Current salary: Date left (if relevant): Notice required: State briefly your main duties and responsibilities and your position within the organisation. If you are no longer in this post, please state your reason for leaving.

4 EMPLOYMENT HISTORY Please give details of all paid and non-paid time employment including family responsibilities since leaving full time education. Employer Post title Brief description of activity/ responsibility or duties Full time or part time Dates To From Reason for leaving Please explain any breaks in your continuity of employment:

5 SUITABILITY FOR JOB This section is for other relevant information to support your application. Please give examples where appropriate.

6 REFERENCES Please nominate two referees. If you are working at the moment, one referee must be your present employer. If you are not working with children at the moment but have done so in the past, please indicate the name of that last employer as one of your referees. Referees will be asked for information on disciplinary issues, etc. References will not be accepted from relatives or from people writing solely in the capacity of a friend. Name of first referee Name of second referee Their job title Their relationship to you e.g. headteacher Their job title Their relationship to you e.g. headteacher Organisation name and address Organisation name and address Postcode Telephone Can we contact this referee prior to interview if you are shortlisted? Yes/No Postcode Telephone Can we contact this referee prior to interview if you are shortlisted? Yes/No Please note Outwood Grange Academies Trust reserve the right to contact previous employers to verify information provided on this application form or at interview. ASSOCIATION WITH A DIRECTOR OR GOVERNOR OF OUTWOOD GRANGE ACADEMIES TRUST Do you have a close association with a Director or employee of Outwood Grange Academies Trust, or any academy governor? Yes/No If yes, please give details Their name Their job Department/Academy Your relationship Please note Any applicant who directly or indirectly seeks the support of any Director, Executive member or academy governor for any appointment with Outwood Grange Academies Trust will be disqualified.

7 ADDITIONAL INFORMATION If the job you are applying for involves driving, do you hold a current driving licence and relevant business insurance to use your vehicle for work? Yes c No c Are you applying for this position on a job share basis? Yes c No c If you are offered this position will you have any other paid work? Yes c No c DISCLOSURE OF CRIMINAL RECORDS/SANCTIONS For teaching posts you have to disclose any conviction, warning, reprimand, caution or other order including spent convictions, that are not protected as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order Do you have any convictions, cautions, reprimands or final warnings that are not protected? Yes c No c Any offer of appointment will be subject to satisfactory Disclosure & Barring Service clearance. You must disclose details of any current sanctions imposed by a regulatory body e.g. the General Teaching Council. If you have any such sanctions, please tick here. c DECLARATION I declare that the information on this form is true and accurate. I understand that providing misleading or false information will disqualify me from appointment or may lead to me being dismissed if appointed to the job. My name has not been placed on any list which disqualifies me from working with children. I confirm that I have read the above statements in respect of Disclosure of Criminal Records/Sanctions and understand the requirements of this position. Privacy Notice I consent to the information contained in this form, and any other information received by or on behalf of the Trust relating to my application, being processed by the Trust in administering the recruitment process and to assist with the prevention and detection of fraud. Signature Date If you submit this form electronically, you will be required to sign this declaration if invited to interview.

8 EQUAL OPPORTUNITIES MONITORING FORM Outwood Grange Academies Trust is committed to its equality and diversity policy. We want to do all we can to prevent discrimination in any form and you can help us in this by completing the information below. The information given on this sheet will not be used to make decisions about who is recruited. The form will not be seen by the shortlisting/interview panel. It will be used to improve equality in recruitment and overall service delivery. Your help filling in this form is greatly appreciated. Thank you. JOB REFERENCE No. APPLICANT NO. DATE OF BIRTH (DD MM YYYY) RACIAL OR ETHNIC ORIGINS White British White Irish White other White & Black Caribbean White & Black African White & Asian Other mixed background Indian Pakistani Bangladeshi Other Asian background Arab Black Caribbean Black African Other black background Chinese Gypsy or Irish Traveller Any other DISABILITY Are you disabled? Yes c No c Outwood Grange Academies Trust welcomes applications from disabled people and undertakes to offer every appropriate support to enable them to gain and retain employment. If you are disabled, please identify any adjustments you consider may be necessary in the recruitment process below.

9 GENDER Male c Female c RELIGION / BELIEF please tick only one box Buddhist Hindu Muslim None Christian (all denominations) Jewish Sikh Other religion or belief Prefer not to say SEXUAL ORIENTATION please tick only one box Bisexual Gay man Other Lesbian or gay woman Heterosexual Prefer not to say HOW DID YOU FIND OUT ABOUT THIS JOB? e.g. OGAT website, newspaper (please tell us which), Job Centre etc. EMPLOYMENT Do you work for Outwood Grange Academies Trust at the moment? Yes c No c